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t-UK Ul-l-K-L USE: ----------------------j--------- --- ------------------ ------------ ----------------- APPLICATION FOR SANITATION PERMIT Permit No. ......I............... --------- (Complete in Duplicate) --tDate Issued This Permit Expires 1-Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION--l-AU.-Vil,...avloin Rd. - ---------------------------------------------------------------------------------------------------------------------------------- Owner's Name-------------UOL-ard---2._`Ga.Uthie_r --------------------- Address------- liziremant I -----------------------I- ----------------------------------------------------------------------------------------__------------------------------------ i Contractor's --------------------I---------------- Contractor's Name-------------------5 aTm--------------I---------------------------------------------------- -------------------------------- -----------. Phone----------------------------------- Installation will serve: Residence Apartment House [-] Commercial E] Trailer Court Ej Motel (] Other 0 Number of living units: _kAumber of bedrooms -------- Number of baths -------- Lot size --------- -------------------------- Wafer Supply. Public system Ej Community system [?q Private-ElDepth to Water Table -,.----- ft. Character of soil to a depth of 3 feet: Sand [] Gravel ❑ Sandy Loam 0"' Clay Loam E] Clay ❑ Adobe I _] Hardpan E] Previous Application Made, (If yes,jdate------ ---- -------) No ❑ New Construction: Yes E) No .E] FHA/VA: Yes E] No E] TYPE OF INSTALLATION AND SPECIFICATIONS:ECIFICATIONS: (No septic tank or cesspool permiffed if public sewer is available within 200 feet.) I Sep-Hc Tank: Distance from nearest well----X-4-----Distance from foundation------------------- Material_....___---_-_.__..__ - ------------------------ F1 No. of compartments----------------------------Size----------------------------------Liquid clep�h--------------------------Capacity----------------------- Disposal Field: Distance from nearest well----AIA------Distance from f oundati`cn___A0 IFT_Distance to nearest lot line____________qT Number of lines!____-_ Length of each line--------- Width of trench.-__. ------ ------ AfjZ pju 'ferial X - --- ,Jjg�of filter ma .... ..7_A%AKDepfh of filter maferia 'IF----------Total length-----I A------------------------------- Seepage Pit: Distance to nearest wefl----------------------Distance from foundation__-_._____-____-_Distance to nearest lot line___-_.---_______ i ❑ Number ine----------------- .Number of pits--- -------------------Lining material---------_---_---- Size; Diameter-----------------------Depth----------------------------- Cesspool: Distance from nearest well--------------_Distance from foundation ---- --------------Linfng material---- - -- ---------------------- ❑ Size: Diameter--_(____._----_--__. ----- - ---Dept h----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from,nearest well------------------ ------------------------------Disfance from nearest building--------_--------------------------------. ❑ uilding------------------------------------------ F1 Distance to nearest lot line--- -,------------------- Remodeling and/or repairing (describe):------Addition-Joiting ding---S ys A. 4 i em-----ontrim--wati I__zity__.syst_e_m__av_a1....... ------------ -isttao-hed-,--p10-t- ----------------------------------------------------------I----------------------------------------------- ------------------------ ------------------------------------ ------------- --------I_------------ - ----------- -- ------------------------- --------- -------------------------I - I----------------------------------------------------------------------------------------------------------------------------- - -- --------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances State Z nd rule nd regular' ns of the San Joaquin Local Health District. [a i, a/ (Signed}-------'v-------------------- ------ ------------------ --------------------------------- --------------------------------------- -(Owner and/or Contractor) By:-------------- --------------------------------- ------------------------------------------ -------------------------------- - -----(_Rf le)----------------------------- ----------- --- ---- ------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ----tr_i ------------ -------------------------------------------- DATE-./ REVIEWED BY ----------- -------------------------------- -- --- --------- DATE------- BUILDING ATE-------BUILDING PERMIT ISSUED----------------------------------------------------------------------------------- - ---------------- DATE---------------------------- ----------------- -------------- Alterations and/or recommendations:------- ------------------------------ -------- --------------------------------------------------- - -------------------------------------------- ------------------- ----------------------------------------------------------------------------------- ----------------------------------------------------------------- --------------------- ----------------------------------------------- ------------ --- - ------------------------------------------------------------------------------------------------------- ----------------------------- ------------------------------ ------- -----------------I :------------ ------------------------------------------------- -----------------_----------- -- ---------------------- -------------------------------- ------------------------------ - - -----_--------------I ----------------------------------------------------------------------------------------- --------------------------------------------- ��_ . FINAL INSPECTION BY:. __Jv--- ----------------------------- Date----- ------------------------------------- - --------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street A 124 Sycamore Street -2-25 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C E3.